Carbon Dioxide Level between Nasal High-Frequency Oscillatory Ventilation and Synchronized Nasal Intermittent Positive Pressure Ventilation after Extubation in Neonates: A Cross-over Randomized Controlled Trial.

Autor: Baingam K; Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand., Phatigomet M; Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand., Thatrimontrichai A; Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand., Maneenil G; Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand., Dissaneevate S; Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand., Janjindamai W; Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Jazyk: angličtina
Zdroj: American journal of perinatology [Am J Perinatol] 2024 Aug; Vol. 41 (11), pp. 1495-1503. Date of Electronic Publication: 2023 Jun 20.
DOI: 10.1055/a-2113-3284
Abstrakt: Objective: Nasal high-frequency oscillatory ventilation (nHFOV) and synchronized nasal intermittent positive pressure ventilation (sNIPPV) yield a lower partial pressure of carbon dioxide (pCO 2 ) after extubation than nasal continuous positive airway pressure. Our aim was to clarify which of the two was superior.
Study Design: We performed a crossover randomized study to evaluate pCO 2 level among 102 participants from July 2020 to June 2022. Intubated preterm and term neonates with arterial lines were randomly allocated to nHFOV-sNIPPV or sNIPPV-nHFOV sequences; their pCO 2 levels were measured after 2 hours in each mode. Subgroup analyses were performed for preterm (gestational age <37 weeks) and very preterm (gestational age <32 weeks) neonates.
Results: The mean gestational age (nHFOV-sNIPPV, 32.8 vs. sNIPPV-nHFOV, 33.5 weeks) and median birth weight (1,850 vs. 1,930 g) did not differ between the sequences. The mean ± standard deviation pCO 2 level after nHFOV (38.7 ± 8.8 mm Hg) was significantly higher than that after sNIPPV (36.8 ± 10.2 mm Hg; mean difference: 1.9 mm Hg; 95% confidence interval: 0.3-3.4 mm Hg; treatment effect [ p  = 0.007] but no sequence [ p  = 0.92], period [ p  = 0.53], or carryover [ p  = 0.94] effects). However, the difference in pCO 2 level between the sequences was not statistically significant in the subgroup analyses of preterm and very preterm neonates.
Conclusion: After neonatal extubation, the sNIPPV mode was associated with a lower pCO 2 level than the nHFOV mode with no significant difference in preterm and very preterm neonates.
Key Points: · Full noninvasive ventilation support is suggested in neonatal ventilation.. · pCO2 level in sNIPPV was lower than in nHFOV.. · No differences in pCO2 levels were observed in either preterm or very preterm neonates..
Competing Interests: None declared.
(Thieme. All rights reserved.)
Databáze: MEDLINE
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